Pharmacological management of behavioral disturbances in patients with Alzheimer’s disease
Pharmacological management of behavioral disturbances in patients with Alzheimer’s disease
复制标题
阿尔茨海默病患者行为障碍的药物治疗
DOI：
10.1080/14656566.2020.1745186
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发表时间：
2020
影响因子：
3.2
通讯作者：
Mimura M
中科院分区：
文献类型：
--
作者：
Nagata T;Shinagawa S;Nakajima S;Noda Y;Mimura M
阿尔茨海默病(AD)的病程中不可避免地会出现神经精神症状(NPS)，包括精神病、攻击性和抑郁症。NPS的药物治疗的有效性一直是有限的，因为它们缺乏疗效，由于不良不良事件而停用，或依从性差。在最近的共识指南中，NPS的非药物治疗已被列为一线管理策略。对严重NPS的药物治疗应作为二线治疗方法，建议从较低的剂量开始，然后滴定到最低有效剂量，并持续一段有限的时间。然而，最近的研究表明，与安慰剂相比，一些接受药物治疗的患者没有表现出治疗效果。NPS中几个子症状同时出现，使得很难专门针对一个症状。因此，目前的综述集中在AD患者这种难治性NPS的治疗策略上。最近的随机对照试验表明，无论积极的治疗方法如何，NPS的严重程度都会以一种时间依赖的方式逐渐减轻。因此，临床医生应从多方面考虑NPS亚症状的潜在原因，并在长期病程中选择替代治疗方法(如神经调节或重新安置到专门护理单元)。
Neuropsychiatric symptoms (NPS) inevitably occur during the course of Alzheimer’s disease (AD) including psychosis, aggression, and depression. The effectiveness of pharmacological treatments for NPS has been limited because of their lack of efficacy, discontinuation due to undesirable adverse events, or poor adherence. In recent consensus guidelines, non-pharmacological treatments for NPS have been prioritized as first-line management strategies. Pharmacological treatments for severe NPS should be administrated as a second-line approach, and have been suggested to be started at a lower dosage followed by titration to a minimum effective dosage and for a limited time period. However, recent studies have shown that some patients receiving pharmacological treatments do not exhibit treatment efficacy in comparison with placebo. The concurrence of several sub-symptoms in NPS makes it difficult to target one symptom exclusively. Therefore, the current review focuses on a strategy for such refractory NPS in patients with AD. Recent randomized controlled trials have shown that the severity of NPS gradually reduces in a time-dependent manner regardless of active treatments. Therefore, clinicians should consider potential causes of NPS sub-symptoms from multifactorial aspects and select alternative treatments (e.g. neuromodulation or relocation into specialized care units) during the long-term disease course.